1386101566 NPI number — THE MEMORIAL HOSPITAL

Table of content: (NPI 1386101566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386101566 NPI number — THE MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MEMORIAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386101566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 N SHIAWASSEE ST STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWOSSO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48867-1601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-729-4781
Provider Business Mailing Address Fax Number:
989-729-4971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9900 W M 21 STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVID
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48866-9798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-862-4858
Provider Business Practice Location Address Fax Number:
989-862-5355
Provider Enumeration Date:
02/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
TREMAIN
Authorized Official First Name:
JORRI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
989-729-4466

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1386101566 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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